Predictors of 12‐Month Mortality for Older Adults With Trauma: A Study of Patients Aged 65 and Older Admitted to a Major Trauma Service

BACKGROUND: Older adults with trauma often have a complex interplay of frailty, multimorbidity and injuries intersecting to impact outcomes. This study aimed to explore the association between frailty, age and injury severity score with in-hospital mortality, 12-month mortality for people who survive hospitalisation and 12-month all-cause mortality in people aged 65 and older admitted following trauma. METHODS: The study was undertaken at a level one trauma centre and included all people aged 65 years and older admitted following trauma. The primary outcomes were in-hospital mortality and 12-month all-cause mortality. Covariates included age, sex, frailty, mechanism of injury and injury severity score (ISS). Regression analysis was conducted to explore the factors associated with mortality. RESULTS: 1381 patients were included, with median age of 79 years (IQR 73-87). Low fall was the most common mechanism (63.9%), and 55.1% of patients were frail (CFS ≥ 4), while 61.2% were minor trauma. 244 (17.5%) patients had died by 12 months post admission, with 101 of those deaths occurring prior to discharge. Frailty was associated with both in-hospital and 12-month all-cause mortality, while a higher ISS was only associated with in-hospital mortality. Multivariate analysis for in-hospital mortality showed CFS and ISS were significant factors, and the ISS group had higher odds ratio (OR 2.61, 95% confidence interval CI 2.07-3.33, p < 0.0010). For 12-month all-cause mortality, multivariable regression showed age, CFS and low fall were significant. CONCLUSIONS: Even for older adults who initially survive a traumatic injury, mortality remains high within the next twelve months, particularly for those who are also frail. This has important implications for care planning for older adults with trauma.